Less invasive surgical procedures can reduce patient trauma, and as a result, may reduce the length of hospital stays, as well as hospital and medical costs. Endoscopic surgery recently has provided a significant opportunity to reduce the invasiveness of numerous surgical procedures. This type of surgery involves the use of an endoscope, an instrument that permits the visual inspection and magnification of cavities within the body. Endoscopes may be flexible, semiflexible, or rigid. An endoscope may be inserted through a small surgical incision to view organ structures in a body cavity or through a natural orifice such as the mouth, anus, bladder, and vagina to view lumen-containing organs in the gastrointestinal, respiratory, and genital and urinary tracts. Endoscopes have channels for irrigation, suction, and the insertion of accessory instruments when a surgical procedure is performed
During a surgical procedure, surgeons often are required to repair or reconstruct a tear or defect or otherwise approximate or fixate tissue or other material by suturing. However, the ability to suture through an endoscope technically is limited. In response to this problem, surgeons have sought alternatives to conventional suturing techniques that are more appropriate for use through an endoscope. Among these alternatives include the use of endoscopic clips.
While the use of endoscopic clips has alleviated some problems associated with suturing through the end of an endoscope, there is still room for improvement in their design and use. For instance, as presently used, the “legs” of clips are joined at their proximal ends. This configuration requires the distal ends of the legs to have a fixed distance and relationship between them. These fixed relationships limit a surgeon's ability to position the clip appropriately in relation to a particular tear or defect or other area in need of treatment. For instance, these clips may not be able to address a tear or defect with certain curves or angles and may not be able to span the width of a larger tear or defect. Further, because the proximal ends of the legs are joined, a surgeon may not be able to adjust the positioning of one leg of the clip without affecting the positioning of the second leg. Positioning also may be limited because the clip may not be properly oriented when it is placed within the actuating jaws of the cannula, or the clip may slip out of alignment during application. Finally, the legs of presently-used clips must be actuated and anchored at the same time. If unequal pressure is applied to the legs during anchoring, scissoring of the legs may occur and further tissue damage may result.